Dr. Daumit trained in Internal Medicine at the Massachusetts General Hospital (1993-1996). At Johns Hopkins, she was a Robert Wood Johnson Clinical Scholar (1996-1998), and is presently a Fellow in the Division of General Internal Medicine and the Welch Center for Prevention, Epidemiology, and Clinical Research. She is committed to improving care delivery for persons with mental illness, and is working with senior faculty members with strong experi3ence in mental illness research. She seeks this Mentored Clinical Scientist Development Award to study access to care and coordination of health care delivery among persons with a mental illness and a co-morbid medical and/or substance abuse condition. Persons with a mental illness are at substantial risk of having unmet needs for health care. For those with both a mental illness and substance abuse disorder or chronic medical condition, the challengers of meeting needs for care are likely greater. However, much is not known about the effect of specific co-morbidities on the need for health care and the extent of barriers faced in meeting these needs. In particular, information is lacking on what disease-related, sociodemographic, and health system factors put these individuals at risk for poor outcomes. Dr. Daumit will conduct cross-sectional and longitudinal analyses of a community based population using data from the NIMH funded Baltimore Epidemiologic Catchment Area Follow-up Study to examine needs and unmet needs for mental health, substance abuse, and medical treatment. She will assess the contribution of patient sociodemographic factors to needs for care and also study the provision of care by different provider types. She will then examine similar questions in the NIMH funded Maryland Medicaid Patterns and Outcomes Study. In this severely mentally ill population, se will next study the impact of Medicaid managed care on meeting needs for care, and outcomes and quality of care. These studies will allow her to identify characteristics of high risk patients who may benefit from better integrated care systems. In the latter part of the award, she will conduct focus groups with patients, providers, and administrators to explore options for effective mental, medical and addiction care models, ultimately leading to the planning of an intervention to improve care. The combination of research utilizing existing data sources, ongoing studies, and primary data collection in the supportive environment of Johns Hopkins will give Dr. Daumit the experience and tools she needs to develop into an independent clinician research in the epidemiology and health services research of mental disorders.